Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $155.22 / $329.38 / $437.02	Facility		$155.22	$329.38	$437.02
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $25.29 / $34.45 / $78.37	Facility	26	$25.29	$34.45	$78.37
Aetna Facility/Professional Professional Modifier Low / Median / High Price $67.84 / $101.87 / $366.77	Professional		$67.84	$101.87	$366.77
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $23.78 / $30.68 / $80.80	Professional	26	$23.78	$30.68	$80.80
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $46.76 / $73.41 / $134.91	Professional	TC	$46.76	$73.41	$134.91
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $45.00 / $45.00 / $45.00	Professional		$45.00	$45.00	$45.00
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $38.45 / $38.45 / $38.45	Professional	26	$38.45	$38.45	$38.45
AmeriHealth Facility/Professional Facility Modifier Low / Median / High Price $601.41 / $1,236.30 / $1,616.70	Facility		$601.41	$1,236.30	$1,616.70
Capital Blue Cross Facility/Professional Facility Modifier Low / Median / High Price $326.81 / $8,639.91 / $79,506.39	Facility		$326.81	$8,639.91	$79,506.39
Capital Blue Cross Facility/Professional Professional Modifier Low / Median / High Price $109.73 / $113.87 / $165.23	Professional		$109.73	$113.87	$165.23
Capital Blue Cross Facility/Professional Professional Modifier 26 Low / Median / High Price $26.46 / $39.13 / $52.38	Professional	26	$26.46	$39.13	$52.38
Capital Blue Cross Facility/Professional Professional Modifier TC Low / Median / High Price $83.27 / $97.36 / $139.82	Professional	TC	$83.27	$97.36	$139.82
Cigna Facility/Professional Facility Modifier Low / Median / High Price $151.88 / $151.88 / $151.88	Facility		$151.88	$151.88	$151.88
Cigna Facility/Professional Professional Modifier Low / Median / High Price $79.55 / $123.41 / $212.02	Professional		$79.55	$123.41	$212.02
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $21.83 / $34.59 / $53.54	Professional	26	$21.83	$34.59	$53.54
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $50.68 / $88.51 / $163.03	Professional	TC	$50.68	$88.51	$163.03
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $75.20 / $172.10 / $177.27	Professional		$75.20	$172.10	$177.27
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $29.94 / $39.27 / $39.27	Professional	26	$29.94	$39.27	$39.27
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $103.92 / $138.01 / $138.01	Professional	TC	$103.92	$138.01	$138.01
Highmark BCBS Facility/Professional Facility Modifier Low / Median / High Price $203.45 / $359.84 / $943.79	Facility		$203.45	$359.84	$943.79
Highmark BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $30.17 / $30.17 / $41.91	Professional	26	$30.17	$30.17	$41.91
Independence Blue Cross Facility/Professional Facility Modifier Low / Median / High Price $601.41 / $945.29 / $1,616.70	Facility		$601.41	$945.29	$1,616.70
Martin's Point Facility/Professional Facility Modifier Low / Median / High Price $149.68 / $253.60 / $647.25	Facility		$149.68	$253.60	$647.25
Martin's Point Facility/Professional Facility Modifier 26 Low / Median / High Price $25.29 / $39.97 / $84.45	Facility	26	$25.29	$39.97	$84.45
Martin's Point Facility/Professional Professional Modifier Low / Median / High Price $64.81 / $115.94 / $309.23	Professional		$64.81	$115.94	$309.23
Martin's Point Facility/Professional Professional Modifier 26 Low / Median / High Price $24.08 / $37.68 / $80.80	Professional	26	$24.08	$37.68	$80.80
Martin's Point Facility/Professional Professional Modifier TC Low / Median / High Price $49.89 / $87.98 / $196.40	Professional	TC	$49.89	$87.98	$196.40
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $96.50 / $128.69 / $318.60	Professional		$96.50	$128.69	$318.60
Priority Health Facility/Professional Facility Modifier Low / Median / High Price $151.88 / $151.88 / $151.88	Facility		$151.88	$151.88	$151.88
Priority Health Facility/Professional Professional Modifier Low / Median / High Price $84.61 / $128.60 / $212.02	Professional		$84.61	$128.60	$212.02
Priority Health Facility/Professional Professional Modifier 26 Low / Median / High Price $25.06 / $34.72 / $55.96	Professional	26	$25.06	$34.72	$55.96
Priority Health Facility/Professional Professional Modifier TC Low / Median / High Price $52.85 / $91.18 / $162.65	Professional	TC	$52.85	$91.18	$162.65
UPMC Health Plan Facility/Professional Facility Modifier Low / Median / High Price $72.00 / $111.84 / $111.84	Facility		$72.00	$111.84	$111.84
UPMC Health Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $26.48 / $26.48 / $27.57	Facility	26	$26.48	$26.48	$27.57
UPMC Health Plan Facility/Professional Professional Modifier Low / Median / High Price $72.00 / $111.84 / $121.51	Professional		$72.00	$111.84	$121.51
UPMC Health Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $25.76 / $26.54 / $27.57	Professional	26	$25.76	$26.54	$27.57
UPMC Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $44.43 / $85.36 / $93.96	Professional	TC	$44.43	$85.36	$93.96
United Facility/Professional Professional Modifier Low / Median / High Price $71.14 / $108.52 / $192.62	Professional		$71.14	$108.52	$192.62
United Facility/Professional Professional Modifier 26 Low / Median / High Price $23.91 / $30.48 / $51.54	Professional	26	$23.91	$30.48	$51.54
United Facility/Professional Professional Modifier TC Low / Median / High Price $49.32 / $81.03 / $150.90	Professional	TC	$49.32	$81.03	$150.90